We thank Dr Vodenčarević and colleagues for their interest in our article and for providing us with their own experience on intravitreal injections in Tuzla, Bosnia and Herzegovina. Their first concern was about the preparation of the off-label bevacizumab. In our study, bevacizumab was used only in hospitals and not in private centers. The dilution and the preparation of the bevacizumab were done by qualified pharmacists in the central pharmacy of each hospital under strict and controlled hygiene rules. Therefore the issue of contamination during the preparation is quite unlikely. The second question is about the injectors. In hospitals the vast majority of intravitreal injections are performed by trained residents, whereas in private centers these injections are done by certified ophthalmologists. It is our experience that the rate of infection does not vary according to the category of injectors, whether residents or ophthalmologists. The paper mentioned by Dr Nadarevic and colleagues is really a good illustration of that. We respectfully think that residents do not have to wait until the third or fourth year of residency to perform intravitreal injections. Before the era of anti-VEGF intravitreal injections, our residents were trained since the beginning of their residency to inject intravitreal antibiotics for acute postoperative endophthalmitis. Therefore, in most French academic centers, intravitreal injections are also done by ophthalmology residents since their second semester. However, we understand that this could be adapted to the training program of residents, which may vary according to each country. This can only work with good training and supervision and when all the injections are performed according to a strict procedure, regardless of the year of residency. We do really insist on basic hygiene rules coming from Pasteur and Lister.

We fully agree with the conclusion of our colleagues: hygiene and particularly asepsis and antisepsis are the key issues to decrease the number of endophthalmitis occurrences post intravitreal injections.